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The present invention relates to a device and method for preparing graft tissue for tissue replacement surgery. More specifically, the invention relates to a preparation board for tensioning graft tissue prior to implantation at an injury site.
The complete or partial detachment of ligaments, tendons or other soft tissues from their associated bones within the body are relatively commonplace injuries, particularly among athletes. Such injuries are generally the result of excess stress being placed on these tissues. Tissue detachment may occur as the result of an accident such as a fall, overexertion during a work related activity, during the course of an athletic event or in any one of many other situations and/or activities. In the case of a partial detachment, commonly referred to under the general term xe2x80x9csprainxe2x80x9d, the injury will frequently heal itself, if given sufficient time, and if care is taken not to expose the injury to any undue stress during the healing process. If, however, the ligament or tendon is completely detached from its associated bone or bones, or if it is severed as part of a traumatic injury, partial or permanent disability may result. Fortunately, a number of surgical techniques exist for reattaching such detached tissues and/or completely replacing severely damaged tissues.
A typical surgical correction of a tendon or ligament injury involves the fixed attachment of the tendon or ligament substitute (often formed of autogenous tissue harvested from elsewhere in the body) to the area of normal bony attachment so that regrowth and reattachment of the tendon or ligament substitute to the bone is enabled. Attachment of the ligament substitute to the bone is ensured by the use of bone attachment means using xe2x80x9ctraditionalxe2x80x9d attachment devices such as metal staples, sutures over buttons and cancellous bone screws. Such xe2x80x9ctraditionalxe2x80x9d attachment devices have also been used to attach tendon or ligament substitutes to the desired bone or bones. The ligament substitute to bone attachment means must be rigidly situated so that regrowth of the ligament substitute in the bony area of the attachment point is undisturbed.
A common type of injury to the knee is the tearing of the anterior cruciate ligament (ACL). Located in the center of the knee joint and running from the femur (thigh bone) to the tibia (shin bone), through the center of the knee, the ACL is the major stabilizing ligament of the knee. Surgical treatment of a torn anterior cruciate ligament usually involves an arthroscopic surgical reconstruction of the injured ligament. A number of different types of tissues can be utilized to reconstruct the ACL, the most common of which involves harvesting the central third of the patellar tendon with a bone block at each end of the tendon graft. After harvesting the tissue, drill guides are used to place holes into the tibia and femur. By placing the drill holes at the attachment sites of the original ligament, when the graft is pulled through the drill hole and into the knee, it will be placed in the same position as the original ACL. After pulling the graft through the drill holes and into the joint to replace the torn ACL, the graft is then held in place with bioabsorbable screws or metallic screws. New blood vessels are allowed to grow into the graft and the site is allowed to heal.
While the patellar tendon is the most widely used autograft tissue, surgical morbidity associated with its harvest has led to an increase in the use of alternate grafts. Currently proposed alternatives include double stranded hamstring tendons and other soft tissue grafts for creating composite grafts. An exemplary technique for using double stranded hamstring tendons requires pretensioning the tendons on a graft preparation board until they are ready for use. This pretensioning process involves holding the graft tissue across the board and applying a tensile load to the tissue. Before the composite graft is implanted, the tendons can be whip stitched at their ends while under tension to create a secure bundle and prevent fraying.
Once the tendon graft is prepared, the tendons may be doubled over, and then inserted, doubled end first, through a drilled tibial tunnel. Attachment means, such as the ligament fixation device disclosed by Wenstrom, Jr. in U.S. Pat. No. 6,152,928, may be used to secure the doubled end to the opening of the femoral socket. Sutures from the whip stitched ends provide a means by which the composite graft can be connected to an in situ tensioner and the composite graft tensioned and the knee ranged approximately 12 to 14 times from extension to flexion. While maintaining tension and spreading apart the individual strands of the composite graft, the soft tissue graft can be fixed to the anterior tibia. Fixation may be achieved by inserting an expandable sheath up the tibial tunnel, into the opening resulting from the spreading and tensioning of the strands. Fixation may be achieved, for example, by screwing an expander screw into the sheath to engage the sheath with the strands and tibia.
Regardless of whether a patellar tendon or a double stranded hamstring tendon is used, one important factor in ensuring the success of the ACL surgery is the adequacy of tensioning of the graft tissue during its preparation. Current graft preparation boards for pretensioning harvested graft tissue, such as the one disclosed by Schmieding in U.S. Pat. No. 5,415,651, comprise a pair of rudimentary holding blocks that are linearly displaceable along a track. Each end of the graft tissue is secured to a block. Each block is held in position in one of a plurality of predetermined holes along the track by a vertical pin. To effect tensioning of the graft, the pins are released and the blocks moved apart by a fixed length along the track. When the pin or pins align with one of the holes along the track, the blocks are resecured.
Though such a preparation board may provide adequate tensioning of the graft tissue for some types of graft preparations, there is no means to precisely control the amount of tension to be applied. Further, the boards currently available do not allow the user to measure with accuracy the amount of tension being applied. There is thus a need for a graft preparation board that enables the operator to easily to control and monitor the amount of tension to be applied to the graft tissue. There is also a need for a graft tensioner that is able to place higher tensions than normally possible by simply pulling axially on one end of a soft tissue graft.
The present invention avoids the aforementioned problems associated with current graft tension boards by providing a graft preparation board that enables an exact tensioning of soft tissue grafts. In the present invention, the amount of tensile load can be easily determined so that the operator can precisely control the amount of tension to be applied. The present graft preparation board also enables higher tensions to be placed on the tissues to be used in surgery.
In one embodiment of the present invention, the graft preparation board has a platform on which there is a first unit and a second unit. On the second unit is a second grasping element for securing an opposite end of the tissue graft. The first unit includes a tensioning device which comprises a base member and a translating element that extends through the base member. The translating element is connected at one end to a head that extends into a first grasping element for securing an end of a tissue graft. Translating element is connected at an opposite end to a grip. Extending between the grip and base member is a spring mechanism. By deploying the grip, the spring mechanism can be tensioned as the translating element is moved, effecting a linear displacement of the translating element with respect to the head and base member. In this particular embodiment, the translating element can comprise a sliding threaded shaft, and the grip can comprise a knob such that, when the knob is turned, the sliding threaded shaft translates with respect to the head and the base member when the spring mechanism is tensioned.
In another embodiment of the present invention, the translating element can include a sliding shaft having notches or grooves instead of threads that would enable the shaft to incrementally ratchet to allow the first grasping element any number of predetermined distances with respect to base member. It is envisioned that the tensioning device of the present invention could work as well with a pulley or reel system for the translating system.
In one aspect of the present invention, the first and second units may be translatable along the length of the platform. For instance, first and second units can be slidable along a track that extends on the platform. Each unit can be locked in position on the track. The board may include indicia along the side of the platform for determining the length of the graft tissue held between the first and second grasping elements.
In another aspect of the present invention, the first and second grasping elements can comprise jaws. However, first and second grasping element can also be hooks, pins, or posts for engaging an end of the graft tissue to be prepared.
In yet another aspect of the present invention, the base member can include a window having indicia representing units of tension (lbs. and N) surrounding the window. Within the window is an indicator for reading the amount of tensile load being applied to the graft tissue being held within the first and second grasping elements.
Further features of the invention, its nature and various advantages, will be more apparent from the accompanying drawings and the following detailed description of the drawings and the preferred embodiments.